Case Assignment: Roberta Evans, an 81-year-old white

Case Assignment: Roberta Evans, an 81-year-old white woman with type 2 diabetes, lived in a retirement community apartment before admission to a geropsychiatric unit. This retired high school science teacher had been living independently since her husband died 5 years ago. Her only child, a son, had moved to Texas about a year ago. Mrs. Evans drove her car to a local discount store 3 weeks before her admission. Two women approached her in the parking lot and told her that they knew a way to invest her money that would double it overnight. Mrs. Evans went to the bank with them, withdrew $1000, and gave it to them. The women were con artists and disappeared with the money. When her son learned about the scam, instead of calling the retirement community director to report what had happened, he called a friend who lived locally and had him disable his mother’s car battery. When Mrs. Evans’ car would not start, she started walking out on the busy streets. She never considered that her car could be repaired. Mrs. Evans wandered away from the retirement community 2 weeks later and was found several blocks away. She did not know where she was going and could not remember how to get back to her apartment. A police officer brought her back to the apartment director, who called her son. He flew in from Texas the next morning. When he visited his mother in her apartment, he saw plates with dried half-eaten food all over the kitchen and living room. He found a plastic bag with her diabetes supplies and prescription in it. Dirty clothes were strewn about the apartment. Her bathtub faucet did not work. He did not know how long it had been since she had bathed, and his mother could not tell him. She agreed to be evaluated for this change in cognitive status, although she thought nothing was wrong. She was admitted to the geriatric psychiatric unit in a university hospital in her town. The multidisciplinary treatment team met the day after Mrs. Evans was admitted to plan her care. Her son did not know what her most recent baseline behavior was because he had only spoken with her over the telephone. He said he could not detect any changes in their telephone conversations. The patient was able to take care of her activities of daily living independently when she had prompts, especially for hygiene and grooming. Mrs. Evans attended all the unit activities and enjoyed being with her peers. However, she needed to be reminded to go to each session. She told the music therapist that she was glad that he had started the music group that day. She did not remember participating in music therapy the week before. Mrs. Evans ate well and slept through the night. She participated in all the diagnostic testing and did not complain. A magnetic resonance imaging scan of her brain showed some atrophy. Electroencephalography showed mild background slowing. A single-photon emission computed tomography scan of her brain demonstrated lower perfusion in the frontoparietal lobes. Neuropsychological testing showed that the patient had difficulty with short-term memory and visuospatial difficulties. On admission, she scored 23 out of 30 on the mini-mental state examination. She said, “I don’t keep up with these things anymore since I’ve retired.” These findings were consistent with a diagnosis of Alzheimer’s disease. She was started on a Donepezil 5 mg by mouth at bedtime. Before discharge, the geriatric psychiatrist, nurse, and social worker met with the patient and her son to make treatment recommendations. The results of the diagnostic testing were discussed. The patient had asked the team members while she was being evaluated to tell her what was wrong. “I’m not crazy, you know!” she insisted. The son agreed that it was in his mother’s best interest that she be told her diagnosis. The physician told her that she had Alzheimer’s disease. She said at first, “I don’t believe it.” Later, she admitted that she had “memory problems, but I do not have Alzheimer’s disease.” She reluctantly agreed to move to the assisted-living facility in the same retirement community. “I know I need some help with my cooking.” The patient did well in the assisted-living facility. She liked the various activities; in addition, her roommate was a woman who had taught in the same high school in which she had taught. Mrs. Evans responded favorably to the Donepezil. She was able to live in the assisted-living facility for 3 more years before she had to move to the nursing home. Conduct Mental Status Assessment and mini-mental status assessment based on the information provided in the case study. Provide clinical manifestations of this condition. What are the criteria of this condition according to the DSM-V?

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